Psoriasis appears to be an independent risk factor for myocardial infarction, conferring the same magnitude of risk as other major cardiac risk factors, according to Dr. Joel M. Gelfand of the University of Pennsylvania, Philadelphia, and his associates.
Noting that the immunologic abnormalities that give rise to psoriasis may also put patients at risk for other diseases associated with systemic inflammation, including heart disease, Dr. Gelfand and his associates assessed the risk of MI in a population-based cohort study. They used data on nearly 131,000 psoriasis patients treated in the United Kingdom between 1987 and 2002, who were matched with 557,000 control subjects.
After a mean of 5 years, patients with psoriasis had a significantly higher incidence of MI than controls. In those younger than 50 years, psoriasis conferred a similar degree of risk as standard cardiac risk factors. Patients with the most severe psoriasis had the highest MI rate. These findings are consistent with the hypothesis that greater immune activity in psoriasis is related to a higher risk of MI (JAMA 2006;296:1735–41).
The link between psoriasis and MI persisted after the data were adjusted for smoking, diabetes, hyperlipidemia, hypertension, and body mass index, and also appeared to be independent of psoriasis treatments, such as oral retinoids, cyclosporine, and methotrexate. The researchers were not able to examine the role of NSAIDs.
“The link between psoriasis and MI may be mediated by other factors beyond inflammation, such as psychological stress, sedentary lifestyle, or possibly poor compliance with management of CV risk factors,” Dr. Gelfand and his associates noted.